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Home My WebLink AboutBLDE-22-003125 Commonwealth of Official Use Only �L. , Massachusetts Permit No. BLDE-22-003125 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked JRev.1/07] APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date:12/1/2021 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) 875 GREAT ISLAND RD Owner or Tenant CUSHMAN CLARE Telephone No. Owner's Address 4717 ESSEX AVE, CHEVY CHASE, MD 20815 Is this permit in conjunction with a building permit? Yes 0 No 0 (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps Volts Overhead 0 Undgrd 0 No.of Meters New Service Amps Volts Overhead 0 Undgrd 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Re-Bar grounding (Garage) Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of Emergency Lighting grnd. grnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. To No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local 0 Municipal ❑ Other: Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water KW No.of No.of Ballasts Data Wiring: Heaters Signs No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to start: Inspection to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE:Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent.The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE:INSURANCE 0 BOND 0 OTHER 0 (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: Jonathan R Hall Licensee: Jonathan R Hall Signature LIC.NO.: 11925 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:263 CAMMETT RD, MARSTONS MILLS MA 02648 Alt.Tel.No.: *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: OWNER'S INSURANCE WAIVER:I am aware that the License does not have the liability insurance coverage normally required by law.But my signature below,I hereby waive this requirement.I am the(check one) 0 owner 0 owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $50.00 tbOZ-z __Lie, A t:§J CI)h 1 kicrakikb. j, -j A /' . *w t0,...on,,,.Q, ,Di M/ of Use Only • BOARD OF FIRE PREVENTION REGULATIONS Rev.1/0acy and Fee Checked APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All wale be perFlmed in amdance with the Maecachnsetta Electrical Code MEC),527 ChM L2 00 - (p ERA(SW'PRINT1NDa"ORTYPEALLL1NFORM 1201D Date: I I I a, 3 I ea 1 N, City or Town of: \10,,,,•vvk To the Inspector of Wires: 1 By ibis application the maim-zip d gives notice cifhis or her intention to perform the e4P-r*ir-1 work diesenbed below. Location(Street&Number) 8 7 S (r re i Titia a- 64 Owner or Tenant (',0 3 I IvcA,\ Telephone Na. I -Owner's Address . Clo Is this permit in conjunction with a building permit? Yes V No ❑ (Check Appropriate Box) t Purpose of Bailin ge S' Utility Auth.or radon No. Fasting Service Amps / Volts Overhead❑ Undgrd.E No.of Meters New Service Amps / Volts Overhead❑ Undgrd❑ Na.of Meters Number of Feeders and Ampacitp Loon and Nature of Proposed Electrical Work Re l �01 OA JAta C,-g- Comp+of the followia teble may be waived by the Inspector of Wires No.of Recessed Luminaires No.of Ce B-Suap.(Paddle)Fans Na.of Total Transformers KYA Na.of Lzominaire Outlets Na of Hot Tubs Generators gPA • No.of la n,inaires Swimming Pool Above ❑ In- ❑ No.aEmergency Laghtmg ern& um Reettpry1inits No.of Receptacle Outlets No.of Oil Burners FLRB ALARMS No.of Zones Death:ion and No.of Switches Na.of Gas Burners No ofDevices • No.of Ranges No.of Air Cond. Tuna Na.of Alerting Devices Heat• Pump Number Tons KW Na.of Self-Contained Na of Waste Disposers Totals: Detection/Alerfin.E Devices No.of Dishwashers Space/Area Heating KW Local❑ Mumctgala El Other Cotmectio No.of Dryers Heating Appliances KW Sec yo f No. Devices or Equivalent No.of Water KW Na.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent Na Hydromassage Bathtubs Na of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: Attach additional detail if desired or as required by the Inspector of Wires. Estimated Value of Electrical Work 1 S t) ' (When required by papal policy.) Work to Start i► ).3 i a a Inspections to be requested in accordance with MEC Rule 10,and upon campletion. INSURANCE CO GE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance inclnding"completed operation"coverage or its substantial equivalent The unddersigned certifies that such co�is in force,and has exhibited proof of same to the permit issuing office. - CEECK ONE: INSURANCE 11(J BOND ❑ OTHER 0 (Sped') I off*,saltier the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: -S(iinakar. r l t M4,0 del'e't. LIC.NO.: Ucen ee �-krnc.4lae.. k..V I Signature-7 LIC.NO.:-JB _ y� (If applicable,enter"exempt"in the license man line.) Bus.Tel.Na. Sc I-aJGflt; Address: 4 G3 ON,—I' d%l rioy-1). i 6,11 I Alt TeL No.: *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"5"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signalize below,I hereby waive this requirement I am the(check one)0 owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ 3 S"